感冒不仅仅是上呼吸道感染ppt课件

感冒感冒-不仅仅是上呼吸道感染不仅仅是上呼吸道感染2DefinitionThecommon cold(acute viral rhinopharyngitis,acute coryza,viral upper respiratory tract infection,ora cold)isacontagious,viralinfectiousdiseaseoftheupperrespiratorysystem,primarilycausedbyrhinoviruses,(picornaviruses小小核糖核酸病毒核糖核酸病毒)orcoronaviruses.Itisthemostcommoninfectiousdiseaseinhumans；thereisnoknowncure,butitisveryrarelyfatal.3DefinitionCollectively,colds,influenza,andotherinfectionswithsimilarsymptomsareincludedinthediagnosisofinfluenza-likeillness.Often,influenzaandthecommoncoldaremistakenforeachother,evenbyprofessionalhealthcareworkers,butmostoftherecommendedhometreatments(drinkingplentyofwarmfluids,keepingwarm,etc.)aresimilarifnotthesame.Thesymptomsofinfluenzaoftenincludeafeverandaremoreseverethanthecold.4SYMPTOMcough,sorethroat,runnynose,nasalcongestion,andsneezing;sometimesaccompaniedbypinkeye,muscleaches,fatigue,malaise,headaches,muscleweakness,uncontrollableshivering,lossofappetite,andrarelyextremeexhaustion.Feverismorecommonlyasymptomofinfluenza,anotherviralupperrespiratorytractinfection(URTI)whosesymptomsbroadlyoverlapwiththecold,butaremoresevere.Symptomsmaybemoresevereininfantsandyoungchildren(duetotheirimmunesystemnotbeingfullydeveloped)aswellastheelderly(duetotheirimmunesystemoftenbeingweakened).5SYMPTOMAsensationofchillinesseventhoughthecoldisnotgenerallyaccompaniedbyfever,andalthoughchillsaregenerallyassociatedwithfever,thesensationmaynotalwaysbecausedbyactualfever.Inonestudy,60%ofthosesufferingfromasorethroatandupperrespiratorytractinfectionreportedheadaches,oftenduetonasalcongestion.Thesymptomsofacoldusuallyresolveafteraboutoneweek;however,itisnotrarethatsymptomslastuptothreeweeks.6WhatistheDifferenceBetweenInfluenzaandtheCommonCold?SYMPTOMCOMMON COLDINFLUENZAFeverRareSudden onset:Often high:Lasts 3-4 daysHeadacheRareFrequentAches and painsSlightUsual;often quite severeWeaknessRare/mildModerate to extreme;May last up to one monthBed RiddenRareFrequently;may last up to 5-10 daysSnifflesCommonSometimesSneezingUsualSometimesSore ThroatCommonSometimesCoughSometimes;Mild to moderateUsual:Can become severeComplicationsSinus or ear infectionPneumoniaKidney FailureHeart Failure;Can be life threatening7complicationsopportunisticcoinfectionsorsuperinfectionssuchasacutebronchitis,bronchiolitis,croup,pneumonia,sinusitis,otitismedia,orstrepthroat.（脓毒性咽喉炎）PeoplewithchroniclungdiseasessuchasasthmaandCOPDareespeciallyvulnerable.Coldsmaycauseacuteexacerbationsofasthma,emphysemaorchronicbronchitis8Causeandsusceptibilityoneofthe99knownserotypesofrhinovirus,atypeofpicornavirus.Around30-50%ofcoldsarecausedbyrhinoviruses.Othervirusescausingcoldsarecoronavirus(causing10-15%),humanparainfluenzaviruses,humanrespiratorysyncytialvirus,adenoviruses,enteroviruses,ormetapneumovirus.5-15%arecausedbyinfluenzaviruses.Intotalover200serologicallydifferentviraltypescausecolds.Coronavirusesareparticularlyimplicatedinadultcolds.Duetothemanydifferenttypesofvirusesandtheirtendencyforcontinuousmutation,itisimpossibletogaincompleteimmunitytothecommoncold.9CauseandsusceptibilitySleep Lackofsleephasbeenassociatedwiththecommoncold.Thosewhosleepfewerthan7hourspernightwerethreetimesmorelikelytodevelopaninfectionwhenexposedtoarhinoviruswhencomparedtothosewhosleepmorethan8hourspernight.Vitamin D A2009studyfoundthatlowbloodserumlevelsofvitaminDwereassociatedwithincreasedratesofthecommoncold.Arandomizedcontrolledtrialfoundthat104post-menopausalAfricanAmericanwomenlivinginNewYorkgivenvitaminDwerethreetimeslesslikelytoreportcoldandflusymptomsthan104placebocontrols.Alowdose(800IU/day)notonlyreducedreportedincidence,itabolishedtheseasonalityofreportedcoldsandflu.Ahigherdose(2000IU/day),givenduringthelastyearofthetrial,virtuallyeradicatedallreportsofcoldsorflu.10CauseandsusceptibilityExposure to cold weather prolongedexposuretocoldweathersuchasrainorwinterconditionsColdNoevidencethatshort-termexposuretocoldweatherordirectchillingincreasessusceptibilitytoinfection,implyingthattheseasonalvariationisinsteadduetoachangeinbehaviorssuchasincreasedtimespentindoorsatcloseproximitytootherstestthehypothesisthatacutecoolingofthefeetcausestheonsetofcommoncoldsymptoms.ConstrictionofbloodvesselsofthenasalpassageswhichmightleadtoreducedimmunityDecreasedtemperaturemayresultinadropintissuepermeabilityand,asaresult,mayleadtoreducedplasmaleakage.-complementproteins11Pathophysiologysalivaornasalsecretionsofaninfectedperson;inaerosolformgeneratedbycoughingandsneezing;orfromcontaminatedsurfaces.12PathophysiologyMajorentrypointforthevirusisnormallythenose,-backofthenoseandtheadenoidarea.Thevirusthenattachestoareceptor,ICAM-1,whichislocatedonthesurfaceofcellsoftheliningofthenasopharynx.Thereceptorfitsintoadockingportonthesurfaceofthevirus.Largeamountsofvirusreceptorarepresentoncellsoftheadenoid.13PathophysiologyRhinoviruscoldsdonotgenerallycausedamagetothenasalepithelium.Macrophagestriggertheproductionofcytokines,whichincombinationwithmediatorscausethesymptoms.Cytokinescausethesystemiceffects.Themediatorbradykinin(缓激肽）playsamajorroleincausingthelocalsymptomssuchassorethroatandnasalirritation14PathophysiologyThecommoncoldisself-limiting,andthehostsimmunesystemeffectivelydealswiththeinfection.Withinafewdays,thebodyshumoralimmuneresponsebeginsproducingspecificantibodiesthatcanpreventthevirusfrominfectingcells.Additionally,aspartofthecell-mediatedimmuneresponse,leukocytesdestroythevirusthroughphagocytosisanddestroyinfectedcellstopreventfurtherviralreplication.Inhealthy,immunocompetentindividuals,thecommoncoldresolvesinsevendaysonaverage15IncubationperiodandprogressionofdiseaseTheupperrespiratoryviralreplicationcyclebegins8to12hoursafterinitialinfection.Symptomsusuallybegin2to5daysafterinitialinfectionbutoccasionallyoccurinaslittleas10hoursafter.Symptomspeak23daysaftersymptomonset,whereasinfluenzasymptomonsetisconstantandimmediate.Thesymptomsusuallyresolvespontaneouslyin7to10daysbutsomecanlastforuptothreeweeks16PreventionThebestwaytoavoidacoldistowashhandsthoroughlyandregularly;andtoavoidtouchingtheeyes,nose,mouth,andface.Anti-bacterialsoapshavenoextraordinaryeffectonthecoldvirus;itisthemechanicalactionofhandwashingwiththesoapthatremovesthevirusparticles.Rhinovirusescanliveupto3hoursoutsidethebodyontheskinorobjects.In2002,theCentersforDiseaseControlandPreventionrecommendedalcohol-basedhandgelsasaneffectivemethodforreducinginfectiousvirusesonthehandsofhealthcareworkers.Thecommoncoldiscausedbyalargevarietyofviruses,whichmutatequitefrequentlyduringreproduction,resultinginconstantlychangingvirusstrains.Thus,successfulimmunizationishighlyimprobable.17LungdiseaseandInfluenzaGetvaccinatedforbothseasonalfluandH1N1flu接种疫苗，包括季节性流感和H1N1流感Coveryournoseandmouthwithyourarmwhenyoucoughorsneeze打喷嚏时用胳膊挡住口鼻Washyourhandsfrequentlywithsoapandwater勤洗手Alcohol-basedhandcleanersarealsoeffectivewhenwashingisntpossible酒精消毒Avoidtouchingyoureyes,noseormouth避免接触眼睛及口鼻Trytoavoidclosecontactwithsickpeople避免与患病者近距离接触Avoidlargecrowds不去人群密集处Askfamilyandfriendstobemindfulofyourhigherriskandnotexposeyoutotheirsicknessiftheyareill避免和高危人群接触Stayhomeifyouaresick:患病后勿外出For7daysaftersymptomsbegin;or症状出现后7天或症状消失后24消失内Untilclearofsymptomsfor24hoursWatchforpublichealthadvisories,astheserecommendationsmaychange健康咨询Forthosewithasthma,pleaseremembertorefertoandmaintainyourAsthmaActionPlanasnecessary.哮喘患者必要时仍需行哮喘治疗18TreatmentConservative managementTheNationalInstituteofAllergyandInfectiousDiseasessuggestsgettingplentyofrest,drinkingfluidstomaintainhydration,garglingwithwarmsaltwater,usingcoughdrops,throatsprays,orover-the-counterpainorcoldmedicines.Salinenasaldropsmayhelpalleviatecongestion.Treatmentsthatmayhelpalleviatesymptomsincludeanalgesics,decongestants,andcoughsuppressants,first-generationantihistaminessuchasbrompheniramine,chlorpheniramine,diphenhydramineandclemastine(whichreducemucusglandsecretionandthuscombatblocked/runnynosesbutalsomaymaketheuserdrowsy).Second-generationantihistaminesdonothaveausefuleffectoncolds.19TreatmentConservative managementVitaminCinnormalormegadoseshasnotbeenshowntobebeneficialinanormalpopulationforthepreventionortreatmentofthecommoncold.Ithowevermightbebeneficialinpeopleexposedtoperiodsofseverephysicalexerciseorcoldenvironments.Variouscoldmedicinesexisthoweverlittleevidencesuggesttheyareanymoreeffectivethansimpleanalgesics.Theyincludeantitussives,antihistaminesanddecongestantsusuallyincombinationwithananalgesic.Theyarenotrecommendedforuseinchildrenbecauseevidencedoesnotsupporttheireffectivenessandthereareconcernsofharm.20TreatmentAntibiotics Antibioticsonlytargetbacteriaandthusdonothaveanybeneficialeffectagainstthecommoncold.AntiviralsTherearenoapprovedantiviraldrugsforthecommoncold.Nasal steroidstillintrialAlternative treatmentsalternativetreatmentswhichsimilarlylacksolidscientificevidenceincludecalendula,ginger,garlicandvitamin Csupplements.21惠菲宁的主要成分及药理作用惠菲宁的主要成分及药理作用惠菲宁的主要成分及药理作用惠菲宁的主要成分及药理作用马来酸氯苯那敏（扑尔敏）（A）：抑制腺体分泌，减少鼻液后流对咽喉部的刺激以及抗胆碱能活性盐酸伪麻黄碱（D）：选择性地收缩血管，减轻水肿、充血对呼吸道的影响氢溴酸右美沙芬氢溴酸右美沙芬：通过抑制咳嗽中枢，有效控制咳嗽22右美沙芬无成瘾性和呼吸抑右美沙芬无成瘾性和呼吸抑制，临床应用更放心制，临床应用更放心中华医学会呼吸病学分会哮喘学组.中华结核与呼吸杂志,2005,28(11):738-44.周敏,等.中国新药与临床杂志,2005,24(9):693-6.抑制呼吸中枢、成瘾性无呼吸中枢抑制作用、无成瘾性中枢性非依赖性镇咳药中枢性依赖性镇咳药右美沙芬右美沙芬可待因可待因作用于N-甲基-D-天冬氨酸受体和Sigma受体，具有中枢和外周镇咳作用作用于阿片受体，中枢镇咳作用镇咳作用强相当或略强分类作用机理疗效安全性23美敏伪麻溶液：不良反应少，临床应用更放心长期使用甘草可出现水肿、高血压、低血钾等副作用24中医中药感冒的发生主要由于体虚，抗病能力减弱，当气候感冒的发生主要由于体虚，抗病能力减弱，当气候剧变时，人体内外功能不能适应，邪气乘虚由皮毛、剧变时，人体内外功能不能适应，邪气乘虚由皮毛、口鼻而入，引起一系列肺卫症状。口鼻而入，引起一系列肺卫症状。中医将感冒分为风寒型感冒、风热型感冒、暑湿型感冒和时行感冒（流行性感冒）四种类型。根据辨证施治的原则，不同类型的感冒应选用不同的中成药治疗。中成药含有西药成分25感冒感冒-不仅仅是上呼吸道感染不仅仅是上呼吸道感染CommonColdInfluenza Complications Cold like symptomsCold like symptomsFatal Diseases Fatal Diseases 26ComplicationsdealingENTAcuteOtitisMediaAcuteRhinosinusitisAcuteTonsillitisAcuteLaryngitisAcuteEpiglottitis27感冒治疗的几个误区感冒治疗的几个误区乱吃抗生素硬扛着不看医生随便乱输液28慎用抗生素英国的著名的健康和临床医疗研究所(NationalInstituteforHealthndClinicalExcellence)就向大众指出：消炎药在很多情况下都是没有必要的，有时它们不但不能有效控制感染，反而容易导致带有超强抗药性的金黄色葡萄球菌等超级病菌的蔓延。英国还出台了相关的行医规定：英国医生不得向患有耳部感染、咽喉肿痛、扁桃腺炎、支气管炎、感冒、咳嗽等轻微病症患者开抗生素。因此，医生不得不打发他们回家休息，最多给他们服用一些止痛片。29与几种疾病的鉴别感冒与过敏性鼻炎感冒与过敏性鼻炎感冒与百日咳感冒与百日咳 (百日咳杆菌）百日咳杆菌）感冒与猩红热感冒与猩红热（乙型溶血性链球菌）（乙型溶血性链球菌）感冒与脊髓灰质炎感冒与脊髓灰质炎（脊髓灰质炎病毒）（脊髓灰质炎病毒）30H1N1甲型流感31ThanksforyourConcern